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Query: UMLS:C0016382 (flushing)
 6,387 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In this investigation, we describe a modification of Euro-Collins flushing solution which enables this solution to be effective in preventing normothermic postischemic acute renal failure. The left kidneys of Sprague-Dawley rats were briefly flushed in situ by vascular perfusion with Euro-Collins solution and the renal pedicle clamped to render the kidney ischemic and hold the flushing solution in the kidney. Following 1 h of in situ normothermic ischemia, the pedicle clamp was removed and a contralateral nephrectomy of the right kidney performed. In two other groups of rats the same experimental protocol was followed using Euro-Collins solution in which the dextrose in this solution was replaced with a similar osmolal contribution of either sucrose (64 g/l) or mannitol (35 g/l). Rats with kidneys flushed with the standard Euro-Collins solution containing dextrose (n = 24) exhibited significantly higher postischemic daily serum creatinine levels, a greater degree of tubular necrosis, and a higher mortality (75, versus 31%) than unflushed ischemic controls (n = 22). Rats with kidneys flushed with Euro-Collins, containing either sucrose (n = 25) or mannitol (n = 22) in place of dextrose, all survived, exhibited only focal tubular damage as observed by electron microscopy, and most returned to normal serum creatinine levels within 72 h following ischemia. These findings, together with other reports that mannitol- and sucrose-based flushing solutions provide excellent protection during prolonged cold ischemia, strongly argue for the substitution of sucrose, mannitol or other similar protective impermeant agents for dextrose in flushing solutions such as Euro-Collins.
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PMID:Improving Euro-Collins flushing solution's ability to protect kidneys from normothermic ischemia. 393 Sep 35

An in situ flushing solution was evaluated with regard to the following: (1) its ability to protect the kidney during 60, 90, and 120 minutes of normothermic ischemia; (2) the effects of using an intracellular versus extracellular electrolyte composition in the flushing solution; and (3) the ability of the flushing solution to complement in situ hypothermia as a protective measure during long-term ischemia. Rat kidneys were briefly flushed in situ with an isotonic phosphate buffered solution (pH 7.2) containing 50 milliosmole of sucrose. The left renal pedicle was then immediately clamped to render the kidney ischemic and to hold the flushing solution in the kidney. Following removal of the pedicle clamp, a contralateral nephrectomy of the right kidney was performed and daily serum creatinine levels determined to evaluate postischemic renal function. The results indicate the following: (1) the flushing procedure is very effective in preventing postischemic acute renal failure following 60 minutes of normothermic ischemia, but is considerably less effective for ischemic times of 90 minutes or more; (2) an intracellular electrolyte composition in the flushing solution does not improve the protective effects of this solution; and (3) the flushing procedure can significantly improve on the protection otherwise provided by in situ hypothermia.
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PMID:Evaluation of a flushing solution designed to protect kidneys from in situ ischemia. 402 28

Ice-cold intracellular electrolyte flushing followed by cold storage and economy air shipment is the cheapest method to share kidneys for transplantation. This study from 1 center compares 62 primary cadaver kidney grafts imported from other centers to 128 that were retrieved locally. Cold ischemia time was 36.4 plus or minus 8.6 hours (mean plus or minus standard deviation) in the imported group and 24.2 plus or minus 8.8 hours in the locally retrieved group. The significant increase in first week dialysis (71 versus 42 per cent) and 1-month serum creatinine nadirs (2.63 plus or minus 2.73 versus 1.78 plus or minus 1.04 mg./dl.) was explained by longer cold ischemia times in the imported kidney grafts. There were no significant differences between the 2 groups with respect to actuarial kidney graft survivals and serum creatinine levels at 1, 2 and 3 years. Intracellular electrolyte flushing followed by simple cold storage and air transportation provides kidney graft survivals and long-term kidney graft function at minimal expense when the kidneys are retrieved from beating-heart cadavers and have undergone minimal warm ischemia.
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PMID:Comparison of imported with locally retrieved kidneys preserved by intracellular electrolyte flushing followed by cold storage. 633 44

Transplantation of cadaver kidneys after flushing with an ice-cold intracellular electrolyte solution is inhibited by arbitrary time limits on cold ischemia. During the 25-month interval ending March 22, 1982 we transplanted 7 kidneys preserved by this method and cold-stored for 48.2 to 61.4 hours. Of the recipients 86 per cent required dialysis within 1 week after transplantation, the mean serum creatinine nadir within 1 month was 2.1 mg./dl. and the graft survival at 1 month was 71 per cent. The 1-year actuarial cadaver graft survival was 69.2 plus or minus 18.1 per cent. Kidneys preserved by this simple method can be transplanted successfully after 48 hours of simple cold storage.
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PMID:Successful human kidney preservation by intracellular electrolyte flush followed by cold storage for more than 48 hours. 633 45

Transplant centers that do not have pulsatile machine perfusion capabilities are reluctant to accept kidneys from programs that do. Four human kidneys were retrieved by other centers, initially placed on pulsatile machine perfusion pumps for 13 to 28 hours, removed from the pumps, flushed with intracellular electrolyte solutions and cold-stored for 13 to 36 hours before transplantation at our institution. All recipients required dialysis during the first week after transplantation. The 1-month serum creatinine nadir was 2.2 plus or minus 1.1 mg. per dl., and all kidney grafts were functioning 3 months after transplantation. Pulsatile machine perfusion followed by ice-cold intracellular electrolyte flushing and simple cold storage can provide satisfactory renal function when the warm ischemia time is short.
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PMID:Human kidney preservation using machine perfusion followed by intracellular electrolyte flushing. 634 4

Rat kidneys were flushed in situ with selected preservation solutions prior to clamping the renal vessels for 1 hour. Collins and Euro-Collins flushing solutions did not appear to protect the physiologic or morphologic status of rat kidneys when examined 2 days after the ischemic insult. These experimental groups exhibited serum creatinine levels similar to those seen in ischemic controls, correspondingly low urine creatinine levels, anuria, and significant deterioration of the uriniferous tubules as revealed by light and electron microscopy. In situ flushing with hypertonic Sacks or isotonic phosphate-buffered sucrose solutions, however, resulted in significant improvements in serum and urine creatinine levels, prevented anuria, and dramatically improved the morphologic integrity of the uriniferous tubules. Flushing with a phosphate-buffered sucrose solution that contained ATP-MgCl2 further improved the physiologic and morphologic status of ischemic kidneys to the point that they were indistinguishable from the nonischemic controls. The degree of protection obtained by flushing kidneys with the isotonic phosphate-buffered sucrose solution plus ATP-MgCl2 is greater than that provided by any other single pretreatment or posttreatment for ischemia that is currently available. We, therefore, believe that the use of this procedure can provide a valuable approach to surgical situations in which postischemic acute renal failure is a potential problem.
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PMID:Protection of kidneys from acute renal failure resulting from normothermic ischemia. 660 9

The present studies were designed to achieve a good maintenance of energy metabolism as a means of improving the quality of liver preservation in rats. For this purpose, investigation were made whether initial warm ischemia may affect energy metabolism during preservation and oxygen supply during initial cold flushing process may protect energy metabolism. The following are the results. Compared with non-oxygenated groups, the oxygenated groups during the initial cooling process proved to be effective in, 1) reducing the precipitous fall in the ATP level of the liver during the initial cooling process, 2) maintaining the higher ATP level for 8 hours of hypothermic immersion storage, 3) maintaining energy production for 24 hours in intermittent perfusion storage, 4) obtaining a more rapid recovery of energy production in rewarming and reperfusion after 8 or 16 hours of hypothermic immersion storage, 5) obtaining the higher ATP level by high flow rate of flushing. It may be concluded that maintenance of energy metabolism in the preserved liver is related to the degree of interference with energy metabolism during the initial cold flushing and this interference can be prevented by flushing with the oxygenated perfusate of high flow rate.
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PMID:[Experimental study on maintenance of energy metabolism of the preserved liver]. 661 23

No kidney transplant center responding to a kidney preservation questionnaire would accept a kidney flushed with an intracellular electrolyte solution and cold-stored for over 40 hours. This study from one center is a comparison of 50 primary cadaver kidney grafts preserved with an intracellular electrolyte flush followed by cold storage for 40 to 61 hours to 82 primary cadaver kidney grafts preserved by the same method for 9 to 24 hours. Kidneys cold-stored for over 40 hours had a significantly increased requirement for dialysis in the 1st week following transplantation (82% versus 34%) and a significantly increased 1-month serum creatinine nadir (2.3 mg/dL versus 1.7 mg/dL). Actuarial graft survivals and serum creatinine levels at 1, 2, and 3 years after grafting were not significantly different. Cadaver donor methylprednisolone (30 to 60 mg/kg) two to nine hours prior to kidney removal significantly reduced the requirement for 1st-week hemodialysis in the kidneys cold-stored for over 40 hours (60% versus 91%). Kidneys preserved by flushing with cold intracellular electrolyte solution can be successfully transplanted after over 40 hours of simple cold storage when the warm ischemia time is very short.
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PMID:Prolonged human kidney preservation by intracellular electrolyte flush followed by cold storage. 669 44

The effect of 35 minutes of warm ischemia (37C) on renal function and adenine nucleotide content of canine kidneys preserved for 24 and 48 hours in Euro-Collins (EC) solution was investigated. In addition, the effect of donor pretreatment with intravenous mannitol, furosemide and methylprednisolone and the addition of adenosine triphosphate (ATP/MgCl2) to the EC flush and storage solution was studied. Donor pretreatment or the addition of ATP/MgCl2 to the flushing and storage solution did not significantly affect postautotransplant renal function of kidneys stored for 24 hours, although it improved tissue adenine nucleotide levels. Results after 48-hour preservation were significantly poorer. These experiments demonstrate that canine kidneys subjected to 35 minutes of warm ischemia time can be stored for 24 hours in EC solution and thereafter provide immediate life-sustaining function.
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PMID:Successful 24-hour preservation of the ischemic canine kidney with Euro-Collins solution. 675 92

Lower limb ischemia represents the most common single threat to the success of operations for abdominal aortic aneurysms. It can occur because of distal embolization from a number of sites or because of thrombosis either at sites of anastamosis or in diseased arteries at or beyond sites of clamping. Preoperative angiographic studies in patients with missing lower extremity pulses aid in planning reconstructive procedures if ischemia occurs in the postoperative period. Systemic heparinization during the stage of interruption of the circulation and specific techniques of dissection, clamping, anastamosis, flushing, and unclamping resulted in an incidence of 0.57% postoperative limb-threatening ischemia in a series of 700 abdominal aneurysm operations in which the incidence of lower limb gangrene was 0.28%.
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PMID:Abdominal aortic surgery: prevention of lower limb ischemia. 684 83


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